BACKGROUND:Magnetic nanomaterials,as a hot topic in the biomedical field in recent years,are often used to enhance the targeted delivery of drugs to the affected area.OBJECTIVE:To investigate the effects of magnetic nano drug carriers on skeletal muscle injury markers and inflammatory responses in rats with sports injuries.METHODS:Magnetic nanoparticles were prepared.A total of 88 male SD rats were randomly divided into a blank group(n=8),an injury control group(n=32),a Yunnan Baiyao group(n=24),and a magnetic nano-drug carrier group(n=24)by using a random number table method.The latter three groups were modeled with exercise-induced muscle injury(treadmill slope of-16°,running speed of 16 m/min,and training time of 120 min).Immediately after exercise,after verifying the success of the model,Yunnan Baiyao patch was applied to the gastrocnemius muscle of the rats in the Yunnan Baiyao group.Yunnan Baiyao patch loaded with magnetic nanoparticles was applied to the gastrocnemius muscle of the rats in the magnetic nano-drug carrier group.At 24,48,and 120 hours after exercise,blood was drawn from the abdominal aorta of rats to detect the activities of creatine kinase and lactate dehydrogenase,as well as the levels of myoglobin,interleukin-6,and tumor necrosis factor-α.Hematoxylin-eosin staining was used to observe the infiltration of inflammatory cells in the gastrocnemius muscle.RESULTS AND CONCLUSION:(1)Compared with the blank group,the levels of myoglobin,creatine kinase,lactate dehydrogenase and tumor necrosis factorα in the injury control group at 24,48 and 120 hours after exercise were increased(P＜0.05),and the level of interleukin 6 at 24 and 120 hours after exercise was increased(P＜0.05).Compared with the injury control group,the level of myoglobin in the Yunnan Baiyao group at 24 and 48 hours after exercise was decreased(P＜0.05),the activities of creatine kinase and lactate dehydrogenase at 24,48 and 120 hours were decreased(P＜0.05),and the levels of interleukin 6 and tumor necrosis factor α at 120 hours after exercise were decreased(P＜0.05).Compared with the Yunnan Baiyao group,the level of myoglobin in the magnetic nano-drug carrier group at 24 and 48 hours after exercise was decreased(P＜0.05),the activities of creatine kinase and tumor necrosis factor α at 48 and 120 hours after exercise were decreased(P＜0.05),and the lactate dehydrogenase activity was reduced(P＜0.05).(2)Hematoxylin-eosin staining showed that a large number of inflammatory cells infiltrated in the muscle fibers of the injury control group 24 hours after exercise,and then the inflammatory cell infiltration gradually decreased,and the local damaged muscle fibers began to regenerate 120 hours after exercise.A large number of inflammatory cells infiltrated in the muscle fibers of the Yunnan Baiyao group and the magnetic nano-drug carrier group 24 hours after exercise,and then the inflammatory cell infiltration gradually decreased,and the damaged muscle fibers were regenerating 120 hours after exercise,and there was no significant difference from the blank group.(3)The results show that Yunnan Baiyao patch combined with magnetic nanoparticles can accelerate the recovery of exercise-induced muscle injury in rats,and the effect is better than that of Yunnan Baiyao alone.

BACKGROUND:Magnetic nanomaterials,as a hot topic in the biomedical field in recent years,are often used to enhance the targeted delivery of drugs to the affected area.OBJECTIVE:To investigate the effects of magnetic nano drug carriers on skeletal muscle injury markers and inflammatory responses in rats with sports injuries.METHODS:Magnetic nanoparticles were prepared.A total of 88 male SD rats were randomly divided into a blank group(n=8),an injury control group(n=32),a Yunnan Baiyao group(n=24),and a magnetic nano-drug carrier group(n=24)by using a random number table method.The latter three groups were modeled with exercise-induced muscle injury(treadmill slope of-16°,running speed of 16 m/min,and training time of 120 min).Immediately after exercise,after verifying the success of the model,Yunnan Baiyao patch was applied to the gastrocnemius muscle of the rats in the Yunnan Baiyao group.Yunnan Baiyao patch loaded with magnetic nanoparticles was applied to the gastrocnemius muscle of the rats in the magnetic nano-drug carrier group.At 24,48,and 120 hours after exercise,blood was drawn from the abdominal aorta of rats to detect the activities of creatine kinase and lactate dehydrogenase,as well as the levels of myoglobin,interleukin-6,and tumor necrosis factor-α.Hematoxylin-eosin staining was used to observe the infiltration of inflammatory cells in the gastrocnemius muscle.RESULTS AND CONCLUSION:(1)Compared with the blank group,the levels of myoglobin,creatine kinase,lactate dehydrogenase and tumor necrosis factorα in the injury control group at 24,48 and 120 hours after exercise were increased(P＜0.05),and the level of interleukin 6 at 24 and 120 hours after exercise was increased(P＜0.05).Compared with the injury control group,the level of myoglobin in the Yunnan Baiyao group at 24 and 48 hours after exercise was decreased(P＜0.05),the activities of creatine kinase and lactate dehydrogenase at 24,48 and 120 hours were decreased(P＜0.05),and the levels of interleukin 6 and tumor necrosis factor α at 120 hours after exercise were decreased(P＜0.05).Compared with the Yunnan Baiyao group,the level of myoglobin in the magnetic nano-drug carrier group at 24 and 48 hours after exercise was decreased(P＜0.05),the activities of creatine kinase and tumor necrosis factor α at 48 and 120 hours after exercise were decreased(P＜0.05),and the lactate dehydrogenase activity was reduced(P＜0.05).(2)Hematoxylin-eosin staining showed that a large number of inflammatory cells infiltrated in the muscle fibers of the injury control group 24 hours after exercise,and then the inflammatory cell infiltration gradually decreased,and the local damaged muscle fibers began to regenerate 120 hours after exercise.A large number of inflammatory cells infiltrated in the muscle fibers of the Yunnan Baiyao group and the magnetic nano-drug carrier group 24 hours after exercise,and then the inflammatory cell infiltration gradually decreased,and the damaged muscle fibers were regenerating 120 hours after exercise,and there was no significant difference from the blank group.(3)The results show that Yunnan Baiyao patch combined with magnetic nanoparticles can accelerate the recovery of exercise-induced muscle injury in rats,and the effect is better than that of Yunnan Baiyao alone.

Effective symptom management can alleviate the physical and psychological distress experienced by patients with cancer, improve quality of life, and contribute to treatment adherence and improve clinical outcomes. However, most existing guidelines are developed for healthcare professionals, and patients and the public have limited access to standardized and comprehensible guidance on symptom management. To address this gap and to facilitate effective communication and shared decision-making, this study proposes the development of a patient version of the cancer symptom management guideline. The development process will adhere to the methodological framework recommended by the Guidelines International Network and the World Health Organization. The GRADE approach will be employed to assess the certainty of evidence and to formulate recommendations. In addition, the process will be informed by the Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ) instrument and the Reporting Items for Practice Guidelines in Healthcare-Public or Patient Versions of Guidelines (RIGHT-PVG). This protocol outlines the establishment of the guideline working group, the identification and prioritization of key questions, evidence retrieval and appraisal, and the formulation of recommendations, with the aim of ensuring methodological rigor and transparency in the development of the patient guideline and providing methodological reference for similar guideline initiatives.

Objective To compare the efficacy of endoscopic parotidectomy through postauricular incision with conventional incision parotidectomy.Methods A total of 60 parotid tumor patients admitted to Zhejiang Cancer Hospital from March 2023 to March 2024 were selected as the study subjects.Thirty patients had the requirement for small scar cosmetic surgery,and the endoscopic parotid tumor resection of the posterior ear were in endoscopic group,and remaining 30 patients underwent traditional open surgery at the same period in open group.Two groups were compared in terms of operation time,intraoperative blood loss,postoperative drainage volume,length of hospital stay,postoperative complications,nursing satisfaction,and incision satisfaction at one month postoperatively.Results Endoscopic group had significantly lower drainage volume,hospital stay,and postoperative complications than open group,there were significant difference between two groups(P＜0.05).The nursing satisfaction and incision satisfaction in endoscopic group were significantly higher than those in open group(P＜0.05).Conclusion Efficacy of endoscopic parotidectomy through postauricular incision postoperative recovery was faster,the hospitalization time was shorter,and the postoperative complications were less.Perioperative optimization nursing in the endoscopic group improved patient satisfaction,which is worth promoting clinically.

Objective To compare the efficacy of endoscopic parotidectomy through postauricular incision with conventional incision parotidectomy.Methods A total of 60 parotid tumor patients admitted to Zhejiang Cancer Hospital from March 2023 to March 2024 were selected as the study subjects.Thirty patients had the requirement for small scar cosmetic surgery,and the endoscopic parotid tumor resection of the posterior ear were in endoscopic group,and remaining 30 patients underwent traditional open surgery at the same period in open group.Two groups were compared in terms of operation time,intraoperative blood loss,postoperative drainage volume,length of hospital stay,postoperative complications,nursing satisfaction,and incision satisfaction at one month postoperatively.Results Endoscopic group had significantly lower drainage volume,hospital stay,and postoperative complications than open group,there were significant difference between two groups(P＜0.05).The nursing satisfaction and incision satisfaction in endoscopic group were significantly higher than those in open group(P＜0.05).Conclusion Efficacy of endoscopic parotidectomy through postauricular incision postoperative recovery was faster,the hospitalization time was shorter,and the postoperative complications were less.Perioperative optimization nursing in the endoscopic group improved patient satisfaction,which is worth promoting clinically.

Objective:To determine the prevalence, risk factors, and longitudinal associations of loneliness during mid- to late pregnancy with anxiety and depressive symptoms in late pregnancy.Methods:In this prospective cohort study, 1 107 pregnant women at 24-28 weeks' gestation were enrolled between June 2021 and December 2022. Psychological status was assessed during mid-pregnancy (24-28 weeks) and late pregnancy (≥32 weeks) using standardized electronic questionnaires, including the Revised University of California Los Angeles Loneliness Scale (UCLA) Loneliness Scale-Short Form (Cronbach's α=0.82), Patient Health Questionnaire-9 ( α=0.86), and Generalized Anxiety Disorder-7 ( α=0.88). Multivariate logistic regression identified independent risk factors for loneliness. Cross-lagged path models analyzed the longitudinal predictions between loneliness and anxiety/depressive symptoms. Results:The prevalence of loneliness decreased significantly from 10.8% (120/1 107) in mid-pregnancy to 4.8% (37/777) in late pregnancy ( χ2=21.81, P<0.001). Multivariate analysis identified independent risk factors for loneliness: age <30 years ( OR=1.70, 95% CI: 1.15-2.50), annual household income <50 000 CNY ( OR=2.53, 95% CI: 1.28-5.02), unemployment during pregnancy ( OR=1.57, 95% CI: 1.03-2.39), history of alcohol consumption ( OR=1.63, 95% CI: 1.03-2.56), and the presence of mid-pregnancy depressive ( OR=2.76, 95% CI: 1.51-5.04) and anxiety symptoms ( OR=1.65, 95% CI: 1.01-2.71) (all P<0.05). Cross-lagged path models indicated bidirectional associations between loneliness and both anxiety ( β=0.32, P<0.01) and depressive symptoms ( β=0.28, P<0.01). However, the predictive effect of loneliness on subsequent depressive and anxiety symptoms ( β=0.28-0.32) was substantially stronger than the reverse prediction (mid-pregnancy anxiety on late-pregnancy loneliness: β=0.12; mid-pregnancy depression on late-pregnancy loneliness: β=0.11). Loneliness demonstrated high temporal stability (autoregressive effects β=0.29-0.32). Conclusion:Loneliness in mid-pregnancy exhibits a symmetric bidirectional association with anxiety and depressive symptoms in late pregnancy, suggesting it may be a core driver in the development of these emotional symptoms. Younger maternal age (<30 years), low household income (<50 000 CNY/year), unemployment during pregnancy, and a history of alcohol consumption were associated with a higher risk of loneliness and should be prioritized for psychological screening and intervention.

OBJECTIVE To study the improvement effect and mechanism of Shengmai powder on heart failure （HF） mice with qi-yin deficiency. METHODS The mice were randomly divided into blank group （water）， model group （water）， Shengmai powder low-， medium-， and high-dose groups [2.61， 5.22 and 10.44 g/kg （based on crude drug dosage）] and positive control group （metoprolol， 30 mg/kg）， with 10 mice in each group. Except for the blank group， all other groups were subcutaneously injected with D-galactose， and a qi-yin deficiency HF mice model was established by continuous food restriction and weight-bearing swimming. At the same time of modeling， the corresponding medicine/water was gavaged once a day for five weeks. The general state of mice was recorded and the traditional Chinese medicine （TCM） syndrome score was evaluated. Behavioral experiments were conducted to investigate the total distance of open field action， the percentage of immobility time， and the swimming exhaustion time of mice. The contents of aspartate transaminase （AST）， creatine kinase （CK） and lactate dehydrogenase （LDH） in the serum of mice were detected； cardiac function indexes [heart rate， left ventricular ejection fraction （LVEF）， left ventricular end systolic diameter （LVESD）， left ventricular end diastolic diameter （LVEDD）， left ventricular mass index and whole heart mass index] were all detected； the histopathological morphology of mice myocardium was observed； the level of cardiomyocyte apoptosis in mice was detected； mRNA expression levels of B-cell lymphoma 2 （Bcl-2）， Bcl-2 associated X protein （Bax）， and Cleaved-caspase-3 in myocardial tissue of mice were detected； the phosphorylation levels of sarcoplasmic reticulum calcium regulatory related proteins [ryanodine receptor 2 （RyR2） and phospholamban （PLB）] in myocardial tissue of mice were detected. RESULTS Compared with the blank group， the body weight， total distance of open field action， swimming exhaustion time， LVEF， LVEDD， Bcl-2 mRNA expression level in myocardial tissue and PLB protein phosphorylation level in the model group were significantly reduced/shortened （P＜0.05）； TCM syndrome score， the percentage of immobility time， heart rate， LVESD， left ventricular mass index， whole heart mass index， cardiomyocyte apoptosis rate， the contents of CK， LDH and AST in serum， mRNA expression levels of Cleaved-caspase-3 and Bax and the phosphorylation level of RyR2 protein in myocardial tissue were significantly increased （P＜0.05）； there were inflammatory cell infiltration， disordered cell arrangement and obvious myocardial interstitial fibrosis in myocardial tissue. After the intervention of Shengmai powder， most of the above quantitative indexes in mice were significantly reversed （P＜0.05）， the inflammatory cell infiltration in myocardial tissue was reduced， and the degree of fibrosis was significantly reduced. CONCLUSIONS Shengmai powder can improve cardiac function， reduce the level of cardiomyocyte apoptosis and myocardial fibrosis in HF mice with qi-yin deficiency. Its mechanism may be related to the regulation of the expression of sarcoplasmic reticulum calcium regulation related proteins.

Objective:To determine the prevalence, risk factors, and longitudinal associations of loneliness during mid- to late pregnancy with anxiety and depressive symptoms in late pregnancy.Methods:In this prospective cohort study, 1 107 pregnant women at 24-28 weeks' gestation were enrolled between June 2021 and December 2022. Psychological status was assessed during mid-pregnancy (24-28 weeks) and late pregnancy (≥32 weeks) using standardized electronic questionnaires, including the Revised University of California Los Angeles Loneliness Scale (UCLA) Loneliness Scale-Short Form (Cronbach's α=0.82), Patient Health Questionnaire-9 ( α=0.86), and Generalized Anxiety Disorder-7 ( α=0.88). Multivariate logistic regression identified independent risk factors for loneliness. Cross-lagged path models analyzed the longitudinal predictions between loneliness and anxiety/depressive symptoms. Results:The prevalence of loneliness decreased significantly from 10.8% (120/1 107) in mid-pregnancy to 4.8% (37/777) in late pregnancy ( χ2=21.81, P<0.001). Multivariate analysis identified independent risk factors for loneliness: age <30 years ( OR=1.70, 95% CI: 1.15-2.50), annual household income <50 000 CNY ( OR=2.53, 95% CI: 1.28-5.02), unemployment during pregnancy ( OR=1.57, 95% CI: 1.03-2.39), history of alcohol consumption ( OR=1.63, 95% CI: 1.03-2.56), and the presence of mid-pregnancy depressive ( OR=2.76, 95% CI: 1.51-5.04) and anxiety symptoms ( OR=1.65, 95% CI: 1.01-2.71) (all P<0.05). Cross-lagged path models indicated bidirectional associations between loneliness and both anxiety ( β=0.32, P<0.01) and depressive symptoms ( β=0.28, P<0.01). However, the predictive effect of loneliness on subsequent depressive and anxiety symptoms ( β=0.28-0.32) was substantially stronger than the reverse prediction (mid-pregnancy anxiety on late-pregnancy loneliness: β=0.12; mid-pregnancy depression on late-pregnancy loneliness: β=0.11). Loneliness demonstrated high temporal stability (autoregressive effects β=0.29-0.32). Conclusion:Loneliness in mid-pregnancy exhibits a symmetric bidirectional association with anxiety and depressive symptoms in late pregnancy, suggesting it may be a core driver in the development of these emotional symptoms. Younger maternal age (<30 years), low household income (<50 000 CNY/year), unemployment during pregnancy, and a history of alcohol consumption were associated with a higher risk of loneliness and should be prioritized for psychological screening and intervention.

Objective:To investigate the feasibility of individualized primary clinical target volume (CTV) delineation in intensity-modulated radiotherapy for nasopharyngeal carcinoma (NPC).Methods:Clinical data of 87 consecutive patients newly diagnosed with lateralized NPC in Jiangsu Cancer Hospital between October 2016 and February 2018 were retrospectively analyzed. Lateralized NPC is defined as tumor invasion not exceeding the contralateral wall. According to the tumor spread, the primary CTV was optimized as follows: CTV2 only covered the medial part of the contralateral pterygopalatine fossa, whereas the contralateral foramen oval was not included; on the level of parapharyngeal space, the contralateral side of CTV only covered the posterior lateral lymph nodes, whereas the contralateral internal jugular vein was not regularly covered. Failure patterns and 5-year survival [local control rate (LCR), progression-free survival (PFS) and overall survival (OS)] were evaluated by Kaplan-Meier method. Paired t-test and rank-sum test were used to analyze the dose variation in the optimized region and adverse reactions. Results:The median follow-up time was 59.5 months. The 5-year LCR, PFS, and OS were 98.9%, 86.5% and 92.1%, respectively. There was no local recurrence in the optimized area of CTV. Dosimetric comparison results showed that the doses of parotid gland, temporal lobe, cochlea and middle ear on the contralateral side were reduced by 13.45%, 9.14%, 38.83%, and 29.36%, respectively. Four cases (4.6%) developed grade 3 hearing loss, all on the ipsilateral side. The optimized scheme significantly alleviated the hearing loss on the contralateral side compared to that on the ipsilateral side ( P<0.001). Other grade 3 late adverse reactions included cranial nerve injury, subcutaneous fibrosis in the neck and visual impairment, with 1 case each. Conclusion:Individualized primary CTV for lateralized NPC is feasible and safe, with obvious dosimetric advantages and reduced adverse reaction rate, which is worthy of clinical promotion.

Objective:To evaluate the relationship between the mechanism of propofol inhibiting carotid sinus baroreflex (CSR) and GluR2 subunit-containing AMPA receptors in the nucleus ambiguus of rats with type 2 diabetes mellitus (T2DM).Methods:SPF healthy male Sprague-Dawley rats, aged 3 weeks, were selected and fed a high glucose and high fat diet for 6 weeks, and then streptozotocin 30 mg/kg was intraperitoneally injected to prepare a T2DM model of rats. Twenty-four T2DM rats were divided into 4 groups ( n=6 each) using a random number table method: diabetes mellitus-normal saline group (DN group), diabetes mellitus-propofol group (DP group), AMPA receptor agonist-normal saline group (AN group), and AMPA receptor agonist-propofol group (AP group). Another 12 normal rats were selected and divided into 2 groups ( n=6 each) using a random number table method: normal-normal saline group (NN group) and normal-propofol group (NP group). AMPA receptor agonist mibamitor 1 nmol/L (50 nl) was injected into the nucleus ambiguus using a micropipette at 30 min before perfusion of isolated carotid sinus in AN and AP groups. Propofol 45 mg·kg -11·h -1 was infused for 2 h via the femoral vein in NP group, DP group and AP group, and the equal volume of normal saline was given instead in the other groups. A model for perfusing isolated carotid sinus was developed at 20 min after infusion of propofol or normal saline, the intracarotid sinus pressure (ISP)-mean arterial blood pressure (MAP) curve was drawn, and CSR parameters such as maximum slope (PS), threshold pressure (TP), saturation pressure (SP), equilibrium pressure (EP), maximum decrease in MAP reflexivity (RD), and carotid sinus baroreceptor operating range (OR) were recorded. Brain tissues were taken at the end of perfusion, and the expression of GluR2 subunit in the nucleus ambiguus was detected by Western blot and immunofluorescence. Results:Compared with the corresponding normal saline groups (NN group, DN group, AN group), PS and RD were significantly decreased, TP, SP and OR were increased ( P<0.05), and the ISP-MAP curve was shifted upward in propofol groups (NP group, DP group, AP group), the expression of GluR2 subunit in the nucleus ambiguus was down-regulated in NP and DP groups ( P<0.05), and no significant change was found in the expression of GluR2 subunit in the nucleus ambiguus in AP group ( P>0.05). Compared with NP group, PS and RD were significantly decreased, TP, SP and OR were increased ( P<0.05), the ISP-MAP curve was shifted upward, and the expression of GluR2 subunit in the nucleus ambiguus was down-regulated in DP group ( P<0.05). Compared with DP group, PS and RD were significantly increased, TP, SP and OR were decreased ( P<0.05), the ISP-MAP curve was shifted downward, and the expression of GluR2 subunit in the nucleus ambiguus was up-regulated in AP group ( P<0.05). Conclusions:The mechanism by which propofol inhibits CSR may be related to down-regulation of the expression of GluR2 subunits-containing AMPA receptors in the nucleus ambiguus of rats with T2DM.